Congenital lung malformations: an ongoing controversy

Abstract

IntroductionCongenital lung malformations are rare lesions that are most commonly diagnosed antenatally. Management of such lesions, particularly those that are asymptomatic, remains controversial. We undertook a survey to ascertain current practice of surgeons in the UK and Ireland.MethodsAll consultant members of the British Association of Paediatric Surgeons were asked to complete a survey on congenital lung malformations with respect to antenatal management, symptomatic and asymptomatic lesions, and operative techniques.ResultsResponses were received from 20 paediatric surgical centres and highlighted the ongoing variability in management of such lesions, particularly those that are asymptomatic. Twenty per cent of surgeons never resect an asymptomatic lesion and twenty-four per cent always do. The remainder intervene selectively, with size being the most commonly stated indication. Most resections are undertaken via thoracotomy although 35% of surgeons use thoracoscopy for some procedures.ConclusionsNational data based on congenital anomaly registers are needed to determine the natural history of these malformations and to guide future management.

Antenatally Detected Congenital Pulmonary Airway Malformations: The Oxford Experience

“…Twenty percent of surgeons reported never resecting an asymptomatic lesion, whereas 24% would always do so. 15 In our experience, excising asymptomatic lesions is safe with minimal complications. Single-lung ventilation in combination with thoracoscopy provides excellent vision.…”

Surgical intervention strategies for pediatric congenital cystic lesions of the lungs: A 20-year single-institution experience

“…Kotecha [2] also recommended medical observation for asymptomatic children with congenital cystic adenomatous malformations (CCAM) and only promoted surgery for children who were identified as being at risk of developing future symptoms. Peters et al [9] reported that 20% of surgeons in the UK and Ireland never resect an asymptomatic lesion. Ng et al [1] reported that 5% of asymptomatic infants (3/60) developed symptoms associated with CCAM after a median follow-up period of 5 years.…”

Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing

“…While it is widely accepted that CLMs causing hydrops, pneumothorax, or recurrent pneumonia require intervention, the optimal management of asymptomatic lesions is a divisive topic. The main argument in favor of early resection is to decrease the later risk of infection and malignancy within the lesions, risks that some contend are overstated . Thompson et al reported retrospectively on 159 newborns with prenatally‐detected CLMs, 18% of whom were symptomatic and underwent lobectomy in the neonatal period.…”

“…The main argument in favor of early resection is to decrease the later risk of infection and malignancy within the lesions, risks that some contend are overstated. [6][7][8] Thompson et al 9 reported retrospectively on 159 newborns with prenatally-detected CLMs, 18% of whom were symptomatic and underwent lobectomy in the neonatal period. Another 13% became symptomatic with infection and had later resection.…”